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Infections Along the US Mexico Border

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Callie Davies

on 13 February 2014

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Transcript of Infections Along the US Mexico Border

Infections Along the Border
3,141 km
1983 La Paz Agreement:
Defined it as the land within 100 km on either side of the international boundary.
15 pairs of sister cities.
Goal: to protect the environment and public health in the U.S.-Mexico border region.
Border Definition
Vector Borne
Vaccine Preventable
Food Borne
Sexually transmitted
TB (respiratory transmitted)
Cocci (Environmental)
Vector Diseases
West Nile Virus
Dengue Fever
Rocky Mountain Spotted Fever
Vaccine Preventable
Childhood immunization programs have been a success in both countries and in the border area itself.
2009 coverage- U.S. border states ranged from 57% to 87.9%.
95% by age five because of laws for school entry.
Coverage of fully immunized kids 1-4 y/o in the 6 Mexican border states in 2009 was 93.9-99.4%
Mexico's population has a higher vaccination rate than the US because public health nurse goes door to door
Food Borne
Hep A
M Bovis
14.94 million people
7.44 million in the U.S.
7.50 in Mexico
U.S. border population increased by 12%
Mexican border population increased by about 18%.
Estimated by the Border Health Commission to double by the year 2025.
Young population because of high fertility and a continuous migratory flow
About 30% of the Mexican border population and 24% of the U.S. border population is under 15 years of age.

Who Lives There?
Who Travels Across?
According to the CDC, the United States-Mexico land border is the busiest international land frontier in the world.
Each year, tens of thousands of Mexican-born immigrants come temporarily to the United States legally to work 196,000 and 86,000 to study in 2009.
1.2 million daily border crossings into the US.
Mexico is the #1 country for US citizens to enter
Transmission due to mosquito bites, birds are amplifying hosts
Ask patient if they have seen dead birds in their area especially crows
Studies have shown that clusters of dead birds predicted an increase risk 1-2 weeks prior to incidence of human cases.
Rates Along the Border
1,021 cases: 38% from the 4 US border states
Arizona as the leading state with 167 cases and 15 deaths
Almost half of the total deaths from West Nile infections were from border states
According to BIDS most WVN is north of the border in Maricopa. Although there has been a few cases in Pima county.
One Factor that Increases Risk: Tire Piles
Strong market for used tires-millions of tires from the U.S. are imported to Mexico for reuse.
Millions of scrap tires-46 known tire piles throughout the border region.
Breeding grounds for mosquitoes, rodents, and other vectors of disease.
Dengue Fever
Aedes aegypti mosquito
Daytime feeder- unnoticed
Carries virus for lifespan once its infected
Resides around human habitation
Short flight distance and bounce from host to host infecting multiple people in one day
Dengue virus transmission is seasonal, with peak activity in late summer and fall.
In 2011, over 67,000 cases of dengue infection were reported from Mexico, including 4000 cases of severe dengue and 36 deaths
High risk on Mexican border states with over 18,000 reported in 2010 but these are located in the southern areas of the state- for Sonora: Hermosillo and below.
Spring and Early summer
2005: outbreak in Northern Arizona by the Brown Dog Tick.
First time this vector has been identified
Bad: wildlife tick vs brown dog tick which is in human habitat
Rocky Mountain Spotted Fever
2010: 1,682 cases of RMSP were reported in US
AZ had 41 all on tribal lands and from the brown dog tick.
1/3 never recall recent tick bite
2009–2010, over 1,000 cases of RMSF were reported in Mexicali, Mexico.
The Mexicali outbreak was also linked to transmission by Rhipicephalussanguineus, and spread through infected ticks by stray and free–roaming dogs
Cases throughout AZ, but there have been widespread prevention efforts to treat home and dogs.
Drinking Water
Mexico: Access to piped drinking water 78-95%
Access to sewer services ranged from 84% to 95
U.S. border cities: over 98% of the households have access to piped drinking water and treated wastewater services
Colonias- Texas
Education to treat well water appropriately and keep well water stored at a cool temperature.
Hepatitis A
Hepatitis A
Spread via the fecal-oral route
Is more prevalent in low socioeconomic areas
lack of adequate sanitation
poor hygienic practices
Acute hepatitis A incidence has declined by 92 percent between 1995 and 2007, from 12 to 1 case per 100,000
In 2007:
Hep A incidence in US border Arizona: 2.4/100,000
Highest of all the border states
Prevention: hand washing, heating foods appropriately, and avoidance of water and foods from endemic areas.
Hand washing is highly effective in preventing the transmission of the virus since HAV may survive for up to four hours on the fingertips.
What is it?
Street vendors
"Bathtub cheese"
Can be eaten as long as it is pasteurized

Queso Fresco
What infections?
Higher rates in hispanic infants
Can cause miscarriage, premature birth or stillbirth, blood and brain infections
highest rates in hispanics
More recent cases of Queso Fresco
M Bovis
Can cause TB- consumption vs respiration
Resistant to front line therapy infections
2 x risk of death

In 2005 survey of Latina Women:
83% eat queso fresco
82% didn’t know if the queso fresco they ate was from pasteurized or unpasteurized milk
99% received prenatal care for most recent pregnancy- only 1% of them reported that they were told not to eat queso fresco
Educational pamphlets- what is "safe" cheese.
Limited the quantity of cheese able to be brought across the border.
Queso Fresco infection outbreak is now not a current concern; however important to maintain education so it stays that way.
What Has Changed?
Influenza (A/B/Pandemic/Avian)
Seasonal: influenza A or B
Arizona Border 2011-2012 Influenza Season Summary Records:
Total of 1,142 cases of influenza were reported from the border region
Above baseline, but never went above the epidemic threshold of 3.72% for Arizona.
Along Arizona's border 19 providers are enrolled in the "National Outpatient Influenza Like Illness Surveillance Network".
On a weekly bases these sites report the total number of patients seen with Influenza like illness.
ILI is defined as a fever of at least 100 degrees F plus a cough or sore through in absence of a known cause other than influenza.

How do they keep track?
Pandemic Influenza is rare, but are risks
Avian Influenza H5N1, H7N9 in china, and corona virus in Middle East causing severe respiratory syndrome.
Goal is to constantly monitor so we can be quick to respond and react.
Also to identify enough cases to subtype for vaccines.
encourage all healthy people to become vaccinated
Clinical rabies is almost always fatal, so prevention of the disease is priority!
Rabies virus is most commonly transmitted via saliva introduced by a bite or other exposure to an infected host. (open wound too)
In continental U.S. rabies among dogs is reported most commonly along the U.S.-Mexico border (vs bats for most of the nation)
Treatments is only effective prior to invasion of neural tissue.
Disease prevention is entirely prophylactic and includes passive antibody (immune globulin) and active immunization (rabies vaccine)
In 2009, along the U.S. side of the border, Arizona reported a total of 676 (587 males and 89 females) newly reported cases of HIV/AIDS
In 2007, reported new cases of HIV in the Mexican border states ranged from 5-91.
How is HIV different on the border?
Deportation: fear is a deterrent for undocumented individuals from testing services and care.

Education: There is a perception that HIV happens only in certain groups: homosexuals, unfaithful partners, or injection drug users so many do not perceive themselves to be at risk.

Embarrassment: Religion is also prominent along border towns- many fear risk of being discovered and judgement by fellow community members.

Transportation: Many HIV individuals along the border to not have a way to get care in Tucson or Phoenix and do not want to risk being seen by someone they know in a clinic along the border.

Clinic access on Mexico side: recently built
new HIV clinics along the border
Mexico: incidence rates of congenital syphilis among the highest in the nation.
Rates were the highest in Baja California 30 per 100,000 under 1 y/o and 21 for Sonora compared to 0.03 for the nation.
US Border: congenital syphilis ranged from 0.0-25.3 cases per 100,000 live births compared to 8.7 for the nation.
Not many studies done
OBH created a study to investigate the prevalence of C. trachomatis, HPV, and cervical dysplasia among women along the Arizona, US-Sonora, Mexico border.
Women 15 years and older living in the following pairs of Arizona/Mexico communities:
Douglas-Agua Prieta
Nogales, Nogales
Yuma, San Luis Rio Colorado
Tucson, Hermosillo

A total of 2,437 women were recruited.
Abnormal Cytology:
Women on the Mexico side 11.2%
Women on US side 6.9%
The highest prevalence of abnormal Pap smears was 12.4% at Agua Prieta/Canacnea clinic site.
All Mexican study sites had the higher prevalence rates of abnormal paps than the sister cities.
In 2270 women, C. trachomatis prevalence overall was 8.2%.
Numbers have been decreasing as education and awareness have increased since this study
After STDs 2nd Most common
Grows in the soil
60% of all national cases in AZ
Endemic to southwest and Mexican border states
Sonora, Coahuila, Nuevo León, and Baja California considered to be most affected.
Arizona Department of Health services recommends patients with community acquired pneumonia from endemic areas be tested for cocci since valley fever mimics CAP.
Out of 5,000 cases in 2007, 500 were interviewed:
1/5 of Arizonans have never heard of VF
1/3 did not know how it was transmitted.
Study also found that people who did know know what valley fever was had an average of 3.5 rounds of antibiotic before getting serology test for cocci.
Mexico City-only public health lab
BIDS has been working with Mexico and help create systematic testing in labs along endemic areas like the border states.
For the U.S. border states, in 2009, California reported the highest incidence rate in the region (6.7 cases per 100,000 population), while Arizona was 3.9.
California had the highest incidence rate and the highest number of cases (2,470) in the nation.
The six Mexican border states reported TB incidence rates higher than the national average of 13.5 cases per 100,000 population in 2007.
Drug Resistant TB
In 2011: WHO- Mexico had 467 MDR-TB cases
U.S. had 124, according to the CDC
Almost half of the U.S. cases came from California and Texas
Arizona has a low DRTB rate
Treatment can require up to two years or more of medication and potentially months of isolation.
Costs: according to a recent CDC study, treatment on average in the U.S. was about $140,000 and ran as high as $700,000.
The Worry
Mexico rate of TB infection is up to 10 times higher- the resistant strains begin to breed and the same drug regimens are given over and over with little supervision to complete treatment before being cured.
Patients in the U.S. who refuse treatment can be jailed, but Mexico by law can't compel patients to take their drugs.
30% of patients in Mexico don’t complete their TB treatment and there are lack of health workers to offer direct observed therapy to every patient.
How Has Control Improved?
"Meet and Greet"- 6 years headed by BIDS
If a patient with TB is deported or simply moving back to Mexico the local hospital will be notified and a nurse and doctor will come to the port of entry and meet the patient.
Project CURE-TB which helps with refer all for treatment when traveling across the border.
It also delegates on both sides and helps contact the family in contact with infected patient to ensure they are not infected as well.

First isolated from a blood sample in the West Nile province of Uganda in 1937
1999 first outbreak in US
WNV detected south of border in Mexico in 2002
West Nile Virus
CDC, United States-Mexico Public Health, http://www.cdc.gov/USMexicoHealth/

The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance, Emerging Infectious Disease Journal, CDC,

Chlamydial infection in women along the US-Mexico border.

Design and results of the USA-Mexico border human papillomavirus (HPV), cervical dysplasia, and Chlamydia trachomatis study.

Women Along the U.S.-Mexico Border Are at Higher Risk of Chlamydial Infection
The body complete HIV/AIDS resource, CDC http://www.thebody.com/content/art24848.html

Epidemiology and pathogenesis of West Nile virus infection, UpToDate,

Epidemiology of dengue virus infections

Clinical manifestations and diagnosis of Rocky Mountain spotted fever

Risk of Deadly TB Exposure Grows Along U.S.-Mexico Border

US/ mexico border and TB

Who to Contact?
Office of Border Health
Orion McCotter:
(520) 770-3110
520) 770-3307 Fax

Callie Davies MSIII
Pediatric Rotation 2013

Overview of Hep A virus infection

Understanding Knowledge, Attitudes, and Behaviors Related to Influenza and the Influenza Vaccine in US-Mexico Border Communities.

United states- Mexico Border Office, H1N1

Rabies, Clinical Key

What is Border 2012, La Paz Agreement

US Mexico Border Health Commission

Acute Viral Hepatitis in the US mexico border region: data from the BIDS Project, 2009

Revocery of Salmonella, Listeria monocytogenes and M.Bovis from Cheese Enterin the US through Noncommercial Land Port of Entry.

Arizona Border 2011-2012 Influenza Season Summary

Understanding Knowledge, attitudes, and behaviors related to influenza and the influenza vaccine in US mexico Border Communities

AIDS education and Training Center

Office of Border Health, HPV, Chlamydia, and Cerival dysplasia Prevalence Along the Arizona-Sonora Border

The Public Health Significance of
Coccidioidomycosis (Valley Fever) in the US-Mexico Border Region
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